The National Resident Matching Program (NRMP) released its 2025 Main Residency Match results on March 21st, revealing a near-record 94% match rate for a historic number of applicants. This milestone signifies the culmination of years of rigorous training for aspiring physicians ready to embark on their residency journeys.

Though, beneath the surface of this success story lies a concerning trend: a growing divergence in specialty preferences that could substantially impact the future of healthcare accessibility in the United States. While certain specialized fields continue to attract top talent, primary care specialties are struggling to maintain their appeal, raising alarms about potential shortages and widening healthcare disparities.

Specialty Preferences: A Tale of Two Trends

The 2025 Match data paints a clear picture: highly competitive specialties like anesthesiology, dermatology, and radiology remain incredibly popular among U.S. medical graduates. These fields frequently enough offer higher earning potential and perceived prestige, making them attractive options for students burdened wiht significant medical school debt.

Conversely, primary care specialties, including pediatrics and family medicine, are facing a concerning decline in interest. This trend is particularly alarming given the crucial role these specialties play in providing accessible and comprehensive healthcare to communities across the nation.

dr.Evelyn Reed, a leading healthcare workforce analyst at the Institute for Healthcare Strategy, emphasizes the potential consequences of this shift. “While the high overall match rate is encouraging, the declining interest in specialties like pediatrics and family medicine, coupled with the continued popularity of fields like anesthesiology, dermatology, and ob/gyn, paints a picture of a potential shortage in key areas of healthcare,” she stated. “This shift highlights the need for proactive strategies to realign the workforce with the evolving needs of the population.”

Bryan Carmody, MD, MPH, a pediatric nephrologist, has observed that the decline in interest in pediatrics has “been slow and steady” over the last decade. This trend underscores the need for innovative strategies to attract more medical graduates to primary care specialties.

The following table illustrates the fill rates for selected specialties, highlighting the disparities in popularity:

Ob/Gyn and Psychiatry: Beacons of Hope

Despite the challenges, some specialties offer a glimmer of hope. Obstetrics and gynecology (Ob/Gyn) residency slots were nearly filled for the second consecutive year, demonstrating the unwavering commitment of medical students to women’s health, even amidst increasing legal and logistical complexities surrounding abortion training and provision. of the 1587 positions available, all but one were filled, predominantly by U.S. MD seniors.

Sandra E. Brooks, MD, MBA, chief executive officer of the American College of Obstetricians and gynecologists, affirmed this dedication, stating, “The overwhelming interest in the specialty reflects the passion and dedication of medical students eager to serve the reproductive and general health needs of patients across the country.”

Psychiatry is another area showing positive growth, with a steady increase in positions and matches in recent years. This progress is partly attributed to targeted efforts within the specialty to address mental health needs across the country. This year, 2380 of the 2388 residency slots were filled, representing an increase of 127 positions and 131 matches compared to 2024.

Match Statistics: A Deeper Dive

The 2025 Match saw a record-breaking 52,498 registered applicants, with 47,208 actively competing for 43,237 positions, according to NRMP data. Both applicant and position numbers increased by 4% from 2024,highlighting the growing demand for residency training in the U.S.

Primary care offered the largest number of residency slots, with 20,300 positions available in internal medicine, pediatrics, and family medicine, marking a new high with an increase of 877 positions over 2024. Internal medicine achieved the highest match rate, filling almost 97% of its 11,750 positions.

However, primary care-focused internal medicine positions experienced a decline, continuing a five-year trend, according to the American College of Physicians (ACP). This subtle but persistent shift underscores the challenges in attracting medical graduates to the front lines of healthcare.

The Vital Role of International Medical Graduates (IMGs)

International Medical Graduates (IMGs) continue to play a crucial role in filling residency positions, particularly in underserved areas. According to the ACP, a significant portion – one-third – of internal medicine residency slots were filled by non-U.S. IMGs. This statistic underscores the vital contribution of IMGs to the U.S. healthcare system.

Davoren Chick, MD, the ACP’s chief learning officer, emphasized that this figure “confirmed the essential role of IMGs in serving US healthcare needs.”

Chick further stated that IMGs “are mission critical” to providing healthcare in America, both during training and “also following training through their disproportionately large role in meeting the needs of medically underserved populations throughout the nation.” this highlights the critical contribution of IMGs in addressing healthcare disparities across the country.

However, challenges remain in ensuring that IMGs receive adequate support and integration into the U.S.healthcare system. Addressing administrative hurdles and providing resources for cultural and professional adaptation are essential to maximizing the contributions of these valuable physicians.

Challenges in Family Medicine

Family medicine experienced a concerning decline in its match rate, dropping from 88% in 2024 to 85% in 2025. While the NRMP attributed this decline to an increase of 144 family medicine positions, Carmody pointed out a long-term decline in interest among U.S. MD seniors,creating a gap that is difficult to fill.

This trend raises concerns about access to primary care, particularly in rural and underserved communities where family physicians are often the sole providers of comprehensive medical services.

The influence of compensation

Financial considerations undoubtedly play a significant role in specialty selection. Medical students, frequently enough burdened with significant debt, are naturally drawn to specialties with higher earning potential, such as surgery, radiology, and anesthesiology.

“Doctors are human beings, and like other human beings, they prefer to have more money rather than less,” saeid Carmody, acknowledging the financial considerations that influence specialty selection.

This economic reality underscores the need to address the financial disparities between primary care and specialized fields to attract more medical graduates to the former.

Supplemental Opportunities

Applicants who did not secure a position through the initial Match had the prospect to participate in the NRMP’s match Week Supplemental Offer and Acceptance Program, with 2521 positions available. This program provides a valuable prospect for unmatched applicants to find a residency position and continue their medical training.

Addressing the Primary Care Gap: Potential Solutions

The declining interest in primary care specialties poses a significant challenge to the U.S. healthcare system. Several strategies could be implemented to address this issue:

• Incentivizing Primary Care: Implementing loan repayment programs and offering higher salaries for primary care physicians could attract more medical graduates to these fields. The federal government and individual states offer various loan repayment programs for primary care physicians who commit to practicing in underserved areas for a specified period.
• Promoting the Value of primary Care: Highlighting the importance of primary care in preventive medicine and chronic disease management can increase its appeal among medical students. Emphasizing the intellectual challenges and the opportunity to build long-term relationships with patients can also make primary care more attractive.
• Improving Work-Life Balance: Addressing the demanding work schedules and burnout rates in primary care can make these specialties more attractive.Implementing team-based care models and utilizing technology to streamline administrative tasks can definitely help reduce the burden on primary care physicians.
• Expanding Training Opportunities: Creating more residency positions in rural and underserved areas can expose medical students to the unique rewards of practicing primary care in these communities. Establishing partnerships between medical schools and community health centers can provide students with valuable hands-on experience in primary care settings.
• Re-evaluating Medical School Curriculum: Exposing students to greater hands-on experiences with family medicine and other primary care specialties early on may help change perceptions. Integrating primary care experiences into the curriculum and showcasing the diverse career paths within primary care can broaden students’ perspectives.

Dr. Reed suggests, “Incentivizing primary care through loan repayment programs and higher salaries, such as, can make these fields more financially attractive. Highlighting the impact of primary care in preventive medicine could increase appeal, and improving the work-life balance of primary care physicians is vital to increasing the appeal and reducing burnout.”

She also emphasizes the importance of expanding training opportunities in underserved areas and re-evaluating the medical school curriculum to expose students to the rewards of primary care early in their training.

Legal and Political Factors

Legal and political factors are increasingly influencing specialty preferences, particularly in fields like Ob/Gyn. The evolving legal landscape surrounding reproductive health services is prompting medical students to carefully consider the implications for their training and future practice.

Dr.Reed notes that “residents may choose to pursue specific institutions or regions that align with their values,while others might avoid certain fields altogether. We may see a geographic redistribution of physicians or a shift towards specialties where these political pressures are less acute. Medical students are going to consider both social factors when they plan their careers.”

This trend underscores the need for open and honest discussions about the impact of legal and political factors on medical training and practice, ensuring that medical students are well-informed and prepared to navigate these challenges.

Balancing Economic Realities

Addressing the financial disparities between primary care and specialized fields is crucial to ensuring a well-rounded and accessible healthcare system. Several strategies can be implemented to balance economic realities with the need for a robust primary care workforce:

• Targeted Scholarships and Loan Forgiveness Programs: Providing financial assistance to students entering primary care or working in underserved areas can help alleviate the burden of medical school debt and make these fields more attractive.
• Reforming Payment Structures: Re-evaluating and reforming payment structures to adequately value primary care services is essential for sustainable practices.Moving away from fee-for-service models and embracing value-based care can incentivize quality and comprehensive care.
• Promoting Team-Based Care Models: Implementing team-based care models can lighten the burden on individual physicians and increase job satisfaction.Utilizing physician assistants, nurse practitioners, and other healthcare professionals can enhance efficiency and improve patient outcomes.
• Encouraging Financial Literacy: Encouraging medical student-led discussions about money and how those factors can affect their future decisions can empower students to make informed career choices. providing financial planning resources and mentorship can definitely help students navigate the complexities of medical school debt and career planning.

Dr.Reed emphasizes that “this is a complex problem and there is no single, easy solution. We have to be prepared to make some changes.”

Future Trends

Looking ahead, several trends are likely to shape the residency match and the broader healthcare landscape in the coming years:

• Continued Sub-Specialization: The trend towards sub-specialization is expected to continue, driven by advancements in medical technology and the increasing complexity of healthcare.
• telehealth Revolution: Telehealth has the potential to revolutionize care delivery and perhaps help reduce the workload for primary care physicians. Expanding access to telehealth services can improve access to care, particularly in rural and underserved areas.
• Data-Driven Workforce Planning: A stronger emphasis on data-driven workforce planning is needed to proactively address emerging needs and shortages. Utilizing data analytics to forecast workforce needs and tailor training programs accordingly can help ensure a well-balanced healthcare workforce.
• Focus on Health Disparities: Health disparities will remain a critical focus, driving efforts to increase diversity within the medical profession. Addressing systemic inequities and promoting culturally competent care are essential to improving health outcomes for all Americans.

Dr. Reed anticipates that “tele-health could revolutionize care delivery and potentially help reduce the workload for primary care physicians. Also expect a stronger emphasis on data-driven workforce planning to proactively address emerging needs and shortages. Health disparities will remain a critical focus, driving efforts to increase diversity within the medical profession.”

Conclusion

The 2025 Residency Match provides valuable insights into the evolving preferences and priorities of future physicians. While challenges remain in attracting students to certain primary care specialties, the dedication and passion of medical students entering fields like Ob/Gyn and Psychiatry offer hope for the future of healthcare in America. Addressing the underlying factors that influence specialty choices is crucial to ensuring a well-balanced and robust healthcare workforce for all Americans.

The trends revealed in the 2025 Residency Match serve as a call to action for policymakers, medical educators, and healthcare leaders to work together to address the challenges facing primary care and ensure that all Americans have access to high-quality, comprehensive medical care.